OLYMPIA -- A state audit has questioned nearly $1 billion that Washington's Medicaid program spent last year -- including $75 million that may have to be repaid to the federal government because it was used for unauthorized medical services for undocumented aliens.

Undocumented aliens received prenatal care, chemotherapy, kidney transplants and other procedures the federal government prohibits its money from being spent on, the audit released Thursday found.

The report examined Medicaid payments in the fiscal year that ended in 2005.

Medicaid, a joint state and federal program, spent $6.2 billion last year on health services for the state's poor and disabled.

"We found no improvements in the ... controls from previous years," the audit said. "Washington state is providing service to thousands of ineligible clients using federal Medicaid money. The majority of these clients were admitted into the program due to unaddressed significant weaknesses in the department's controls. This is causing the nation's taxpayers to subsidize Washington state's non-compliance."

The U.S. Health and Human Services Department began reviewing Washington's Medicaid spending on undocumented aliens in March, but it has yet to determine how much, if any, federal money should be repaid.

State Medicaid Director Doug Porter said the federal report most likely will recommend policy changes and tighter controls on how the federal money is spent.

"We might owe them money back -- we might not," Porter said. "Largely, the federal government will determine: Did we make a mistake that was an honest mistake that can be corrected? Or were we trying to game the system and rip off more federal money than we were entitled to and we knew it? That largely drives the corrective action."

Porter said he hopes investigators' findings will concur with what he believes are the facts: "We were looking at the regulations and making the best sense out of them as we could."

In that case, Porter said he expects the federal government to clarify its rules instead of issuing sanctions and a demand to repay the money.

Porter said he's skeptical that the government will demand the full $75 million to be repaid.

"We think what's really at risk is something on the order of maybe $8 million or $10 million," Porter said.

State Auditor Brian Sonntag said it's not up to his office to decide how much of the total liability would have to be repaid.

"What we're going to do is identify improper payments. We're going to identify problems in the audit report," Sonntag said. "In the follow-up, the federal government will determine what or how much has to be repaid. ... Ideally, you wouldn't want to be misspending any of these dollars."

Sonntag said he's concerned that most of the 28 findings in this year's audit were flagged before.

"A lot of these issues are repeat issues," Sonntag said. "You've read these in previous audit reports, and here they are again."

But on the upside, Sonntag said the response from the new head of the Department of Social and Health Services was encouraging.

"We share a common goal of ensuring the proper use of public funds," she said.

Sonntag said Arnold-Williams' attitude and commitment to resolving audit issues was "very refreshing."

Animosity and a lack of cooperation between agency officials and the auditors marked Sonntag's previous Medicaid audit.

The 2005 audit found that DSHS and Medicaid:

Lack a reliable system to identify treatments and services that are not covered by the Medicaid plan.

Spent federal money on services for undocumented aliens. They did not adequately review pharmaceutical claims for fraud and abuse.

Lack adequate internal controls to prevent Medicaid payments to dead people or people using a dead person's Social Security number.

Porter said the findings could be broken down into three main categories: One, the federal government is giving mixed signals in interpreting its own rules; two, DSHS and auditors are interpreting the rules differently; and three, DSHS and the federal government have agreed on an interpretation of the rules and the Auditor's Office is just wrong.

"We just plain disagree on some issues -- and will likely continue to disagree," he said.

Porter and Sonntag agree that the federal investigation will prove useful in at least clearing up conflicting interpretations.

"What we're looking for is the federal government to come in and provide some clarification to DSHS and to our office," Sonntag said. "This was supposed to happen a couple years ago, and we are very encouraged that it will happen now."

Porter said the department is trying to move quickly to address the problems they do agree on.

"If we haven't already started a correction, we will," he said. "We would like to have that done and in place before his next audit commences"

If duly elected officials, under oath, are aiding anf abetting ILLEGALS to break the law, to obtain unauthorized government benefits using fraudulent documentation, and if elected and appointed officials did, in fact, allow illegals to break the law and allowed illegal access to government agencies, this might be a violation of the Hobbs Act. If elected officials took campaign contributions from illegal aliens, this could be characterized as extortion, and/or bribery, and a violation of the Hobbs Act.

The Hobbs Act was used recently to nail four TENN state legislators and their aides in an extortion scheme. The TENN group was arrested under the federal Hobbs Act, charging extortion, conspiracy to extort and attempted extortion, and accepting bribes as agents of the state. The Hobbs Act covers extortion by public officials, as follows: 2403 Hobbs Act -- Extortion By Force, Violence, or Fear

Primary investigative jurisdiction of offenses in 18 U.S.C. § 1951 lies with the Federal Bureau of Investigation. The Inspector General's Office of Investigations, Division of Labor Racketeering (formerly the Office of Labor Racketeering), United States Department of Labor, is also authorized to investigate violations of 18 U.S.C. § 1951 in labor-management disputes involving the extortion of property from employers by reason of authority conferred on investigators as Special Deputy United States Marshals. Supervisory jurisdiction over 18 U.S.C. § 1951 is exercised by the following offices with respect to the offenses noted:

1. Extortion under color of official right or extortion by a public official through misuse of his/her office is supervised by the Public Integrity Section, Criminal Division.

2. Extortion and robbery in labor-management disputes is supervised by the Labor-Management Unit of the Organized Crime and Racketeering Section, Criminal Division.

3. All other extortion and robbery offenses not involving public officials or labor-management disputes are supervised by the Terrorism and Violent Crimes

Public officials on the government payroll misusing your tax dollars are engaged in fiduciary negligence and have placed the financial interests of tax-exempt investors and bondholders of your state's transportation and highway bonds, municipal school bonding, and utilities bonding, in jeopardy.

WHen elected officials ignore illegal aliens registering to vote using phony documentation, and ignored illegal aliens fraudulently voting on bond issues referenda, that might be classified as a felony, and could negate a state's school and municipal subdivisions' tax-exempt bond issues.

The SEC wants to know when the financial interests of tax-exempt bondholders have been jeopardized, and whether other illegalities occured. They should be advised of these concerns. EMAIL enforcement@SEC.gov

=====================================================

Bonding agents, and banks, doing business with states and their municipal subdivisions are registered broker-dealers and members of the National Association of Securities Dealers (NASD) and the Securities Investor Protection Corporation (SIPC). NASD and SIPC should also be contacted regarding your concerns about fiduciary negligence, and use of tax funds for illegal activity.

=======================================================

Banks doing business with your municipalities that are conducting illegal activity are jeopardizing bank patrons, shareholders, and depositors and should be reported as follows:

The Office of the Comptroller of the Currency (OCC) is the primary federal regulator for national banks. The OCC's Customer Assistance Group is available to assist customers with questions or complaints concerning national banks. Email to Customer.Assistance@occ.treas.gov.

You can reach one of the OCC Customer Assistance Specialists by calling toll free number, 1-800-613-6743, Monday-Thursday, 9-4, and Friday 9-3.

=================================================

Moreover, if banks excercised fiduciary negligence and misused the sanctioning power of the FDIC in improper ways, and engaged in illegal activity with government funds, that should also be pursued with the FDIC.

=================================================

And of course, elected officials fiduciary negligence conducted in collusion with state agencies, banks, and securities dealers that jeopardize tax-exempt bondholders should be reported to the IRS.

======================================================

FREEPER ACTIVISM

EMAIL THE DEPT OF JUSTICE: ASKDOJ@USDOJ.GOV

PHONE THE IRS IN YOUR AREA

ICE Phone 1-866-347-2423 http://www.ice.gov/graphics/about/index.htm

===================================================

FREEPER ACTIVISM

Because they have the power of the purse---and control your tax dollars---public officials who represent you are required to be bonded. They might have incurred imprisonment, fines, or other criminal penalties for violating the terms of bonding by misusing your tax dollars.........specifically by aiding and abetting the activities of illegal aliens, and failing to report that crimes were being committed.

Public officials might have lied on insurance bonding applications, and may have filed false bonding applications and/or insurance claims. Similar penalties apply to insurance organizations. St. Paul Fire and Marine Insurance Co--is one such company that provides bond insurance for public officials. Check it out in your area.

8
posted on 04/28/2006 7:30:46 AM PDT
by Liz
(We have room for but one flag, the American flag." —Theodore Roosevelt)

yes and that is my largest gripe about the illegal alien thing. They are actually "stealing" services from American citizens. Think about it I believe there are up to 30 million illegals here and we supposedly have a population of 300 million. That means one in 10 people in this country is illegal. Wouldn't we like to cut the healthcare budget, local on up by 10%? How about education...10% automatic cut, you could go on and on.

The Rep administration in Colorado canceled presumptive prenatal eligibility for Medicaid prenatal care a couple of years ago because it found out that about 1/2 of the people being certified for the program were ineligible--usually because they were illegals. Was costing tax payers $6 to $9 million annually depending on the estimate you believe.

Dem legislature immediately passed statute reinstating presumptive eligibility. Told citizens peope would have to prove citizenship. In fact, all that was required was that a woman state that she was eligible, a so-called "presumptive declaration."

Federaly qualified community health clinics were main offenders. If person was Medicaid client they could charge "reasonable costs" under federal law--about $130 a visit. Plan old doctors seeing patients could only charge $30 for same thing.

Great info Liz.........has there been any feedback from anyone using this info to nail some of these public officials yet? As time permits, I plan to make some inquiries with my local officials and I was curious how we get around their stories about having to follow federal law when it comes to dealing with illegals.....such as health care, Motor voter, etc.?

We know that each illegal child in education costs is 14k a year. So before they enter high school to bring down the education of American kids, they already cost us $112,000.00 each. Figure they are poor and have nothing else to do but breed more children into poverty, so that is often 3-11 kids x $112k.

They absolutely roll out the red carpet for illegals here in WA state. The big agribusiness fruit companies on the eastern side of the state, and the forest-based businesses on the western side love to hire illegals, and the People's Republic of Washington serves them well.

They figure the rest of us are all going to either work in government, or write code for Microsoft.

21
posted on 04/28/2006 3:56:20 PM PDT
by hunter112
(Total victory at home and in the Middle East!)

All elected officials, in their capacity as fiduciaries of public monies, are required, by law, to be bonded. The express purpose of bonding is to protect the public's money. Each state sets their own regulations. Now, say public funds went missing and the public official failed to get bond coverage; the state would have no way to recover that money other than restitution through a criminal prosecution. If, it is determined a public official broke the law by failing to apply for bond coverage, that could be an actionable offense.

Concerns here center on instances when elected officials allowed government agencies to misuse tax dollars-----allowing illegal using phony documentation to get government benefits, to vote in elections for public bond issues...........this is an example of fiduciary negligence, and could violate the state's bonding regulations, and the bonding requirements of the carrier.

Now, if a public official with bonding had previous financial problems---perhaps a bankruptcy or a job loss for financial improprieties, etc---that they failed to reveal to bonding agents, that might subject them to legal penalties.

22
posted on 04/28/2006 4:50:40 PM PDT
by Liz
(We have room for but one flag, the American flag." —Theodore Roosevelt)

Another thing: Any of you know about this? I heard that Washington's former RAT governor, Gary Locke, just before he left office last year, signed an excutive order to grant the children of illegal aliens "in-state resident status" for state-assisted tuition to attend the University of Washington and other state universities. But if you're a US citizen and you're from Montana, or Utah, or Iowa, you are S.O.L. You still must pay "out-of-state" tuition! Go figure.

OLYMPIA, Wash. -- Washington state's Medicaid program made nearly $1 billion in questionable payments last year, and may have to refund millions of dollars for improperly paying illegal immigrants' medical bills, a state audit said Thursday.

The sweeping review by state Auditor Brian Sonntag also questioned the state Medicaid agency's investigation of some abuse claims and its controls on identity fraud and prescription drugs, including steroids.

Officials with the state Department of Social and Health Services disputed some findings, but said they would work with Sonntag to iron out conflicting rules that govern health care programs.

"We share a common goal of ensuring the proper use of public funds," said Robin Arnold-Williams, the department director.

A yearly probe of Medicaid spending is required under federal law because the federal government splits the program's costs with the states.

The 155-page audit released Thursday covers the state budget year that ended in June 2005. Washington's Medicaid program spent more than $6.2 billion in that period, Sonntag said.

Auditors identified nearly 30 problem areas for the program. The nearly $1 billion in questioned spending includes more than $83 million in payments for thousands of illegal immigrants' medical expenses.

Half of that money came from the federal government, which only allows its share of Medicaid to be spent on undocumented immigrants in emergencies.

The state was paying providers for non-emergency care, including treatments for ingrown toenails, dental care and acne, auditors said.

That total includes up to $32 million in federal money spent on care for pregnant undocumented immigrants, despite an order to limit that care to childbirth. The state may have to refund that money to the federal government, the audit said.

Auditors from the federal inspector general are now performing their own review of the state's Medicaid spending on undocumented immigrants, officials said.

The DSHS, which oversees Medicaid, said it has since improved policies for tracking improper spending. The federal audit should clear up any other policy misunderstandings, the department wrote.

State auditors also reviewed the department's policy for sex-change surgeries, some breast surgeries, and other potentially "elective" procedures. State Medicaid officials said they had paid more than $110,000 for two gender-reassignment surgeries since 2000, and about $12,600 for corrective surgery after a sex-change operation performed in another country.

The agency has since started to deny requests for sex-change surgeries, saying in a statement that it found "other therapies were equally effective, less costly and incur less risk."

Three people have appealed such denials, and the cases are not yet resolved. Three others have placed initial requests for Medicaid coverage of the surgeries, the state said.

Sonntag noted that the latest audit was much smoother to perform than the previous review, which was not completed after auditors said state officials were not cooperating.

"It's not a fight this time, and we both want to be able to look to the feds for some resolution, and I think that's going to happen," he said.

$1 Billion in Medicaid Expenses Questioned by the State Auditor DSHS continues to be plagued by repeat audit findings

OLYMPIAThe State Auditor issued 28 audit findings today concerning the state's administration of the $6.2 billion Medicaid program (state and federal funds). These findings lead State Auditor's Office (SAO) to question nearly $1 billion in costs for the program; 16 percent of all dollars spent. The auditor also issued 21 audit findings against the Department of Social and Health Services (DSHS). This follows last year's audits in which the State Auditor issued 19 findings against DSHS (14 of which have not been resolved) and 22 audit findings in the state's Medicaid program (18 of which have not been resolved).

Bob Williams, President of the Evergreen Freedom Foundation, released the following comments in response:

"Any repeat audit finding is unacceptable, let alone the news that a majority of the problems identified last year have not been corrected. State officials' failure to follow the law has potentially led to $1 billion in consequences for taxpayers.

"Taxpayers and those individuals actually eligible for assistance pay the price when state officials refuse to enforce eligibility requirements.

"Until the legislature and governor ensure strict consequences exist for state agencies violating the law, we will continue to see year after year of the same audit problems and countless waste of taxpayer dollars.

"As noted by the State Auditor, 'Lack of compliance with federal regulations could jeopardize future federal funding.' This could mean the loss of billions of dollars."

OLYMPIA  Washington may have to repay up to $32 million in federal funds it spent on medical care for illegal immigrants, state auditors said Thursday, in two reports detailing nearly $1 billion in "questioned costs."

The audits covered the state Department of Social and Health Services and the state's $6.2 billion Medicaid program. DSHS is by far the largest state agency, with 17,000 employees and a budget of about $8 billion a year.

"We're talking a substantial amount of public dollars  federal and state money  and the ability of those dollars to be accounted for," said State Auditor Brian Sonntag.

"The sad thing is the number of repeat violations," said Bob Williams, a former state lawmaker who now heads up the conservative Evergreen Freedom Foundation. "There's no excuse for this."

DSHS officials agreed with some of Sonntag's findings but disputed others. Many of the situations are not as clear-cut as the audits suggest, they said. The agency, they said, is moving quickly to improve its cost controls and fraud detection.

"That gets lost," said state Medicaid director Doug Porter. "The auditor's told to go out and find things that are weaknesses."

Among the audit findings:

The state is improperly using federal tax dollars to pay for routine medical care for illegal immigrants, when only emergency care should be covered. Of $103 million the state paid to health care providers in fiscal year 2005 for treatment of illegal immigrants, auditors found millions of dollars in billing codes for cosmetic dentistry, eye exams, contraception, carpal tunnel syndrome, ingrown nails, acne and hearing exams.

State workers are not consistently verifying Social Security numbers for people applying for Medicaid health coverage. "Further," one audit report states, "the Department does not heed federal alerts notifying staff of invalid Social Security numbers."

The state is paying widely-varying prices for the human growth steroid Somatropin. Auditors say that the state paid from $47.79 to $5,061 per dose, "at the same dose and even the same provider."

Washington's Aging and Disability Services Administration isn't making sure that complaints of abuse, neglect, financial exploitation and death at residential care facilities for the elderly, disabled or developmentally disabled get investigated according to federal guidelines. In most cases, auditors found, the state relies on the facilities to do their own investigations.

The state has paid for two people to have sex-change surgery since 2000, with three other people currently appealing the state's denial of their requests to pay for sex changes.

 DSHS doesn't have sufficient safeguards to prevent people from getting state-paid medical care by using a dead person's Social Security number. In Medicaid billings from fiscal year 2005, auditors said they found hundreds of instances of medical bills charged on behalf of dead people.

DSHS made duplicate payments totaling nearly $117,000 to social service providers.

State Rep. Bill Hinkle, R-Cle Elum, said he wasn't surprised by the findings. Political leaders must find the will, he said, to make tough changes.

"I think it's hilarious that the Democrats want to talk about universal health care when we can't even do Medicaid," said Hinkle. He's calling for creation of a state inspector-general office to police fraud and improper spending.

"(New DSHS head) Robin Arnold-Williams, to her credit, is doing the best she can," said Hinkle. "But she's new, and she's inherited a mess."

Sonntag also praised Arnold-Williams, saying that she's made the agency much more cooperative with his auditors. She's responsive, he said, and aggressive in trying to address problems.

But most of the problems cited by auditors are not as black and white as they sound, DSHS officials said Thursday.

Federal rules, for example, specify that federal dollars can only be spent on medical care for undocumented aliens in medical emergencies. But they don't define well what constitutes an emergency, said Porter. If a roofer, say, falls and breaks his arm, that's clearly an emergency. But, Porter said, it's unclear if it's still an emergency when he goes back six weeks later to have the cast removed.

Of the $32 million in questioned spending, he said, "We think they were services that people desperately needed, and we felt obliged to pay for them. We've erred on the side of trying to be reasonable."

As for the wildly different prices paid for Somatropin, he said, the differences were due to different strengths, packaging and other factors. (The auditor's office, however, disputes this.)

And the sex-change operations? Medicaid is required to pay for "medically necessary" treatment, Porter said. Until about three years ago, sex-change surgery was a covered procedure. But the state now refers people who feel they're the wrong gender to psychotherapy and hormone treatment, which Porter said have proven equally effective treatments. A few people have appealed that decision. The state is resisting, but if they win their cases, Washington will likely have to pay for additional sex-change surgeries.

Contrary to what the audit reports say, state workers do check Social Security numbers for people seeking Medicaid coverage, Porter said. But a federal directive, he said, also prohibits the state from refusing coverage to people who won't provide a number.

Lastly, another DSHS official disputed the audit finding that DSHS isn't ensuring that complaints about residential care  including nursing homes, boarding homes, adult family homes  are investigated properly. Yes, the facilities investigate their own complaints, said quality assurance administrator Sheldon Plumer, with the Aging and Disability Services Administration. But the state reviews those investigations and often requires more information. In about 5 percent of the cases, he said, the state will do its own investigation.

April 16, 2006 Mrs. Gregoire promotes entitlements for illegal immigrants Mrs. Gregoire1 objects to a new federal law that would require Medicaid recipients to document citizenship or legal immigration status, the New York Times reports: "Medicaid Hurdle for Immigrants May Hurt Others"

"This provision is misguided and will serve as a barrier to health care for otherwise eligible United States citizens," said [Mrs.] Gregoire of Washington, a Democrat.

Ms. Gregoire said the provision would cause hardship for many older African-Americans who never received birth certificates and for homeless people who did not have ready access to family records.

The article is full of similar dire predictions. But there is exactly one quote based on actual experience: In Georgia, Medicaid officials began enforcing a similar requirement in January. Dr. Rhonda M. Medows, commissioner of the state's Department of Community Health, said it had not caused serious problems. One gets the impression that those who advocate for unlimited entitlements to illegal immigrants simply view them as just another bloc of constituents.

hat tip: reader J.W.

1 Joni Balter has never retracted her incorrect report that

State election officials are not aware of a single documented instance where a non-citizen voted in the governor's race.

Posted by Stefan Sharkansky at April 16, 2006 11:27 AM |

Comments: Gregoire's "career" was built on Fraud. New opportunities for political corruption can only help further her fraudulent occupation of an office to which she was not elected.

Posted by: GregoireNotGov on April 16, 2006 12:27 PM 1 If I went to Asia, Europe, or Latin America and demanded their governments to pay for my healthcare, they would laugh at me and deport me. 2 Gregoire is being her normal goofy self, but what do you expect from someone who mismanaged the AG's office for 12 years? 3 Since to qualify for medicaid or medicare, you need to have a social security card, there is already a paper trail 4 There are other valid records than passports 5 If you did not get a birth certificate, there baptism certificates, military records, driver's licensees, social security records, BIA records, et al. 6 Let's see how many individuals there are without standard documents, before we say the rule is impossible to enforce 7 Just like Jim McDermott fights for our parents who get caught in the Medicare/caid Catch 22 form letters, McDermott and the other Representatives will fight on this issue also. 8 Gregoire's been drinking Ron Sims Sound Transit punch. 9 There are probably not that many individuals in the worse case scenario 10 If Greg Nickels has time to fine residents for not properly sorting their garbage/recyclables, he has time to help valid citizens/residents produce suitable alternative documentation 11 Enuff said

I heard that Washington's former RAT governor, Gary Locke, just before he left office last year, signed an excutive order to grant the children of illegal aliens "in-state resident status" for state-assisted tuition to attend the University of Washington and other state universities.

It's true, but let's not forget the Rat legislature that passed that bill in the first place. Like I said, this state rolls out the red carpet for illegals.

29
posted on 05/03/2006 2:38:17 PM PDT
by hunter112
(Total victory at home and in the Middle East!)

Disclaimer:
Opinions posted on Free Republic are those of the individual
posters and do not necessarily represent the opinion of Free Republic or its
management. All materials posted herein are protected by copyright law and the
exemption for fair use of copyrighted works.